Important AFP online content on HPV infection includes a recent clinical overview of its manifestations, testing, and prevention; and short drug reviews of the quadrivalent and bivalent vaccines. The latter review notes that the bivalent vaccine "does not protect against the two strains of HPV responsible for genital warts and is of no value in males."

What do you think of the new ACIP recommendation, especially in light of recent political controversies over HPV vaccine mandates? Have you been following the ACIP's previous recommendation to routinely administer HPV vaccine to girls, and if so, do you now plan to do so with boys? We would love to hear your thoughts.

Monday, October 17, 2011

A new clinical practice guideline on ADHD from the American Academy of Pediatrics is making some waves among pediatricians and family physicians for its recommendation to evaluate and treat children as young as age 4 years. Past AAP guideline statements focused on identifying and treating children between the ages of 6 and 12 years. Although the AAP recommends behavior therapy as first-line treatment for younger children with inattentiveness or hyperactivity, it includes the option of starting medications in children who do not respond to behavior therapy. "In areas where evidence-based behavioral treatments are not available," the guideline adds, "the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment." It may only be a matter of time, then, before stimulants are being prescribed to large numbers of preschool-aged children.

Although unrecognized ADHD can cause significant social problems and learning difficulties in affected children, data on the incremental benefits and harms of detecting ADHD in younger (as opposed to school-aged) children and the long-term effects of stimulant medications is limited. As you consider how to incorporate information from this new guideline to the care of children your practice, we hope that you will find the AFP By Topic Collection on ADHD to be an indispensable resource.

Monday, October 10, 2011

A recent national survey of internal medicine and family physicians published in the Archives of Internal Medicine found that 42 percent of physicians felt that their patients were getting "too much" health care, while only 6 percent thought that patients were receiving "too little." These opinions contrast with multiple previous studies showing that primary care clinicians fall short when it comes to providing guideline-recommended care; a 2007 study, for example, found that children received less than half of indicated care.

So which is it: too much care, too little, or some of both? And how can AFP help family physicians avoid these extremes and strive for the happy medium, which in other fields is known as the "Goldilocks Principle"? In addition to bringing readers the latest Practice Guideline updates, such as the Centers for Disease Control and Prevention's 2011-12 recommendations for influenza vaccination, we provide information that allows you to evaluate these guidelines against the best design criteria previously proposed by AFP Deputy Editor Mark Ebell, MD, MS:

The best guidelines share several characteristics: they begin with a comprehensive review of the literature; they carefully assess the quality of the literature to identify the best studies; they base their recommendations on the best studies; and they tell us the strength of the evidence that supports each key clinical recommendation. In other words, they are founded on the principles of evidence-based medicine, which strives to make decisions on the best available information—“best” implying that the evidence is graded, so that one has a sense of what is good evidence and what is not, and “available” implying that the literature search is comprehensive. Transparency is the key: readers should know why each recommendation is made and whether it represents opinion, theory, or fact. Finally, guidelines should be independent of industry support (an all-too-common occurrence) and should clearly identify any potential conflicts of interest of the authors. Ideally, guideline authors should have no conflicts of interest, which can diminish the quality and validity of the guideline.

There are, of course, many reasons - financial, medical-legal, and practical, to name a few - that care may diverge from that supported by the best evidence-based guidelines. Still, we hope that every section of the journal makes it easier for family physicians to provide care that is "just right."

Friday, October 7, 2011

According to an article in today's New York Times, U.S. Preventive Services Task Force officials have confirmed that they plan to release an updated recommendation statement on screening for prostate cancer early next week that changes their current "I" (insufficient evidence) statement to a "D" grade ("recommends against"). Our AFP By Topic collection on Cancer includes several resources that may help you explain this upcoming change in practice to your colleagues and patients:

Monday, October 3, 2011

Physicians who regularly treat patients with upper respiratory infections are familiar with the 2005 federal law that moved the decongestant pseudoephedrine "behind the counter" to make it more difficult to illegally manufacture the stimulant methamphetamine. Unfortunately, "meth" abuse is only the tip of the iceberg of over-the-counter medication abuse. In an editorial in the October 1st issue of AFP, Drs. Chih-Wen Shi and Margaret Bayard provide helpful tips on recognizing and treating this common problem in the primary care of adolescents and young adults:

When treating a patient for a drug overdose, it is important to screen for multiple drugs, because many OTC cough and cold medications contain more than one active ingredient. Furthermore, overdoses can occur with a combination of OTC, prescription, and illicit drugs, as well as alcohol and other substances. In such instances, toxicity may be additive. Reporting overdoses to poison control centers is crucial so that data can be collected to support policy changes, such as placing an OTC drug behind the pharmacy counter or taking it off the market.

You can find additional current AFP content on the prevention, diagnosis, and treatment of substance abuse in our AFP By Topic collection.

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The opinions expressed here are those of the authors and do not necessarily reflect the opinions of the American Academy of Family Physicians or its journals. This service is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.